A letter arrives from your insurer. Somewhere in it is the phrase Minor Injury Guideline, and the message underneath it is that the money for your treatment is capped. If you are in pain, not sleeping properly and unable to do your job, being told your injury is minor is a hard thing to read.
The word minor here is not a medical opinion about you. It is a category in Ontario’s auto insurance rules. Being placed in it is a decision, and a decision can be challenged.
The MIG is one part of a larger system. Our Ontario accident benefits page explains the rest of what your own insurer pays.
What the Minor Injury Guideline is
The Statutory Accident Benefits Schedule is the set of rules that governs what your own insurer pays after a car accident, regardless of who caused it. The MIG is a separate document, Superintendent’s Guideline No. 01/14, in force since February 2014. It is incorporated by reference into the Schedule and is binding for that reason, under section 268.3 of the Insurance Act.
The Guideline sets out a streamlined treatment framework for a defined group of injuries. The Schedule then caps what the insurer has to pay for medical and rehabilitation benefits where your impairment is predominantly a minor injury.
What counts as a minor injury
The definition is a list. A sprain, a strain, a whiplash associated disorder, a contusion, an abrasion, a laceration, a subluxation, and any clinically associated sequelae, which means symptoms clinically connected to one of those injuries.
That last phrase does a great deal of work, and it is frequently where the argument sits.
What the cap actually is
Where the MIG applies, medical and rehabilitation benefits are capped at $3,500 plus applicable HST.
What a MIG designation actually costs
The figure to measure it against is the one that applies to everybody who is not held to the minor injury limit. For those claimants, medical, rehabilitation and attendant care benefits share a single combined limit of $65,000 plus applicable HST. Where the impairment is catastrophic, that combined limit is $1,000,000 plus applicable HST.
Those are the standard limits, and they are not the whole story. They are higher if optional benefits were bought when the policy was taken out or renewed. The optional medical, rehabilitation and attendant care benefit raises the non‑catastrophic limit to $130,000, and a further option raises it to $1,000,000 with no time limit on when the expenses have to be incurred. Where the impairment is catastrophic, the optional coverage takes the combined limit to $2,000,000.
Most people have no idea what they bought. It is not something you are likely to remember from a renewal form. Send us your policy and we will tell you which limits actually apply to you.
What optional benefits do not change is the minor injury cap itself. The $3,500 is fixed by section 18(1) of the Schedule, and the optional coverage replaces the limit that applies to everybody else. So if you did pay for extra coverage, a MIG designation costs you more, not less.
So a MIG designation is, at the very least, the difference between $3,500 and $65,000 of available coverage, and a good deal more than that if optional benefits were purchased. That is what is actually at stake in these disputes.
There is also a time limit that applies whichever category you are in. For someone 18 or older at the time of the accident, no medical, rehabilitation or attendant care benefit is payable for expenses incurred more than 260 weeks after the accident. For someone under 18 at the time, the limit runs instead to their 28th birthday. Neither time limit applies to a catastrophic impairment, and the optional coverage described above can remove it as well.
Inside that cap, the Guideline runs on its own published fee schedule and its own paperwork. Treatment is confirmed on a Treatment Confirmation Form (OCF‑23) rather than a treatment plan, and the schedule sets out what the insurer pays:
- $215 for the initial visit
- Three four week treatment blocks across the first twelve weeks, at $775, $500 and $225
- $85 for the discharge report, payable once
- Up to $400 of supplementary goods and services, which the Guideline allows without the insurer’s approval
Those items come to roughly $2,200 of the $3,500. Treatment beyond the schedule has to be justified to the insurer on a Treatment and Assessment Plan (OCF‑18). The framework is built around a twelve week functional restoration programme, on the assumption that early focused treatment restores function.
What the MIG does not decide
Being placed in the MIG affects medical and rehabilitation benefits. By itself it does not decide:
- Whether you can work, or whether income replacement benefits are payable
- Whether non-earner benefits apply
- Your right to sue the at-fault driver, which is a separate claim running on its own timetable
Attendant care sits outside the cap in a particular way. The $3,500 limit covers medical and rehabilitation benefits only. Attendant care is funded out of the combined limit described above, and that combined limit applies only to people who are not subject to the minor injury limit. The practical effect is that there is no attendant care funding inside the MIG.
How people get out of the MIG
- The injuries are not predominantly minor. If you have an injury that falls outside the definition, the category may be the wrong one.
- A pre-existing condition. The rules provide an express way out, and the wording matters. The cap does not apply if your health practitioner determines and provides compelling evidence that you have a medical condition that was documented by a health practitioner before the accident and that will prevent you from achieving maximal recovery if you are held to the cap. Each of those three requirements has to be met. The evidence goes in on a Treatment and Assessment Plan (OCF‑18).
- How high that bar is. It is worth being straight about this, because the Guideline is. It says that a pre-existing condition will not automatically take an impairment out of the MIG, that the vast majority of pre-existing conditions will not do so, and that it should happen only in extremely limited instances. Having a pre-existing condition is not the argument. Compelling evidence that it will stop you reaching maximal recovery under the cap is the argument.
- The symptoms develop. A recovery that stalls, or problems that emerge later, can point to a longer road than the MIG assumes.
What makes the difference
These disputes turn on evidence rather than argument.
- Consistent treatment records. Gaps in care get read as recovery, even when the real reason was cost or a waiting list.
- Function, not just diagnosis. A diagnosis says what you have. What matters is what you can and cannot do, for how long, and what it stops you doing at work and at home.
- Clear reporting from the people treating you. If you are not improving as expected, that needs to be explained clinically and written down.
Exceptions may apply – legal advice is strongly recommended for your particular situation.
Speak to a lawyer about a MIG designation
Initial consultations are free. Our fee schedule is published in full, by stage of the case, on our Fair Fees page. Call 905-409-2438, send a text, message us on WhatsApp, or use the contact form.
Steven Polak is licensed as a lawyer in Ontario and practises with Lerners LLP at 123 Athol Street, Whitby.